Sustainable Munroe

Viable but not sustainable: Those four words came to define Munroe Regional Medical Center’s fiscal condition during a six-year debate about what to do about the hospital’s financial future.

Viable but not sustainable. Those four words came to define Munroe Regional Medical Center’s fiscal condition during a six-year debate about what to do about the hospital’s financial future — a debate that narrowed significantly with Tuesday’s lopsided defeat of a proposed five-year, 1-mill property tax.Trustees for the Marion County Hospital District, which owns and governs the public hospital, sought the tax and the $65 million it would have generated as a way to avoid selling or leasing the hospital to an outside, for-profit chain. Tax proponents argued that keeping the perennial top-100 hospital under local control was worth the additional tax burden, especially because it is a safety-net hospital.But voters rejected the tax, 58 percent to 42 percent, leaving trustees with few options but to pursue a new lease and, potentially, give up much of their control over the facility. Because the tax was uncertain, trustees have been simultaneously conducting discussions with two major hospital groups about entering a 40-year lease to operate the hospital.Munroe’s greatest need is for substantial amounts of cash for expansion and upgrades. Its facilities and equipment is older than the average Florida hospital, and its reserves have steadily dwindled as trustees were forced to dip into them year after year to balance the budget.Repeated consultants have told trustees that it faces a double-edged sword: significant capital needs in the neighborhood of $150 million and a patient-payer mix that is among the worst in the nation for hospitals Munroe’s size. Medicare and Medicaid patients make up more than 80 percent of Munroe’s clientèle, and the hospital provides nearly $20 million a year in charity care.Yet, through delayed capital improvements, some good-investments luck and prudent management, Munroe has remained financially viable. It just is not financially sustainable — not with its capital needs, its patient-payer mix and the uncertain health care landscape down the road.Trustees will meet this week to determine where to go from here. The voters have narrowed their options, but Munroe still belongs to the people of Marion County.That said, the trustees’ principal task from here on out will be to ensure whatever partnership or lease deal they enter into does as much to preserve or, if possible, improve the services and quality of care that Marion Countians have come to expect from their award-winning community hospital. There no doubt are significant advantages to being part of a hospital group — everything from better insurance payment rates to improved economies of scale to greater access to capital.But what makes Munroe such a remarkable community asset is that not only does it provide some of the best care of any community hospital in the land, it makes that care available to any Marion County resident, regardless of their ability to pay. Keeping Munroe viable and sustainable is the immediate task for trustees. But in pursuing that goal, we trust they will negotiate with this in mind: Munroe is still the people’s hospital, and the aim of any deal should be to ensure it provides the same level of services and care to all the people of Marion County.